Effectiveness of Repetitive Transcranial Magnetic Stimulation augmentation of pharmacotherapy in Obsessive Compulsive Disorder

This study aims to evaluate whether repetitive transcranial magnetic stimulation (rTMS), when added to ongoing standard pharmacotherapy, is more effective than sham rTMS plus pharmacotherapy in reducing the symptoms of obsessive-compulsive disorder (OCD). OCD is a chronic and disabling psychiatric condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Many patients continue to experience significant symptoms despite receiving recommended medications. In this study, 74 patients aged 18 to 55 years, diagnosed with OCD, will be recruited from the outpatient and inpatient services of the Department of Psychiatry, Government Medical College and Hospital (GMCH-32), and Mental Health Institute (MHI). After baseline assessments, participants will be randomly assigned to one of two groups: active rTMS with standard pharmacotherapy or sham rTMS with standard pharmacotherapy. Active rTMS involves the delivery of magnetic pulses over the supplementary motor area to modulate specific brain circuits implicated in OCD. The sham procedure appears identical in setup and sound but does not deliver active magnetic stimulation. Both groups will receive scheduled sessions five days per week for four weeks. Participants will be evaluated at baseline, at the end of the fourth week, and at 10 and 16 weeks using standardized rating scales including the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression (CGI) scale, and Montreal Cognitive Assessment (MoCA). Medication adherence and any adverse effects will be monitored regularly throughout the study period. This study seeks to determine whether augmentation with rTMS results in greater and faster improvement in OCD symptoms and overall functioning compared to pharmacotherapy alone.